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首页> 外文期刊>Current treatment options in neurology >Nonarteritic anterior ischemic optic neuropathy.
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Nonarteritic anterior ischemic optic neuropathy.

机译：非动脉性前部缺血性视神经病变。

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OPINION STATEMENT: Currently there is no generally accepted, well-proven treatment for nonarteritic anterior ischemic optic neuropathy (NAION). Most proposed treatments are empirical and include antithrombotics, vasodynamic agents, treatments aimed at reducing optic disc edema, and various neuroprotective strategies. Most potential treatments have been inadequately studied, prematurely embraced, or prematurely discarded. Evidence for antithrombotic agents is lacking, and small vessel arterial occlusion has never been demonstrated in NAION. Antiplatelet agents have not been studied in acute NAION, but they are often prescribed for acute treatment because of their proven role in stroke prevention. Because NAION is an ischemic disorder occurring more often after the age of 50 in patients with vascular risk factors, I recommend aggressive risk-factor management and antiplatelet therapy. The evidence that aspirin can help to prevent NAION in the fellow eye is divided. I recommend aspirin for secondary prevention, mostly for its proven role in stroke prevention. NAION occurs in patients with physiologically crowded optic nerves and small cup-to-disc ratios. Disc edema may contribute to a "compartment syndrome," which compresses the fine capillary blood supply of the optic nerve head, resulting in ischemia and axonal damage. There is some limited and debatable evidence that oral steroids may shorten the duration of disc edema and improve visual outcome in NAION. I discuss this evidence with patients who present acutely with NAION, and although I consider prescribing oral steroids on a case-by-case basis, I will not routinely recommend oral steroids until a properly randomized clinical trial is performed. Some neuroprotective strategies have been studied, but none have proven to be helpful. Although some (eg, brimonidine) are probably not harmful, I do not recommend these treatments. Early referral to low vision services may help to improve functional visual outcome.
机译：意见陈述：目前，没有针对非动脉性前部缺血性视神经病变（NAION）的公认的，公认的治疗方法。大多数提议的治疗方法都是经验性的，包括抗血栓药，血管动力药，旨在减轻视盘水肿的治疗方法以及各种神经保护策略。大多数潜在的治疗方法尚未得到充分研究，过早采用或过早丢弃。缺乏抗血栓形成剂的证据，NAION从未证明过小血管阻塞。尚未在急性NAION中研究抗血小板药，但由于其在中风预防中的有效作用，通常将其用于急性治疗。由于NAION是具有血管危险因素的患者在50岁以后更经常发生的缺血性疾病，因此，我建议采取积极的危险因素管理和抗血小板治疗。阿司匹林可以帮助预防另一只眼的NAION的证据存在分歧。我推荐阿司匹林用于二级预防，主要是因为它在中风预防中已被证明具有重要作用。 NAION发生在生理上拥挤的视神经且杯碟比较小的患者中。椎间盘水肿可能会导致“房室综合征”，从而压缩视神经头的细毛细血管血液供应，导致缺血和轴突损伤。有一些有限且有争议的证据表明，口服类固醇可以缩短椎间盘水肿的持续时间并改善NAION的视觉效果。我与急诊使用NAION的患者讨论了这一证据，尽管我考虑根据具体情况开处方口服类固醇，但在进行适当的随机临床试验之前，我不会常规推荐口服类固醇。已经研究了一些神经保护策略，但没有一个被证明是有帮助的。尽管某些药物（例如溴莫尼定）可能无害，但我不建议您使用这些治疗方法。尽早转诊低视力服务可能有助于改善功能性视力结果。

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